颈动脉疾病与急性大脑中动脉闭塞患者的侧支循环和梗死灶生长的关系。
Association of Carotid Artery Disease with Collateralization and Infarct Growth in Patients with Acute Middle Cerebral Artery Occlusion.
机构信息
From the Departments of Neuroradiology (R.G., A.P., U.N., N.S., M.A.M., M.B., F.S.) Heidelberg University Hospital, Heidelberg, Germany
From the Departments of Neuroradiology (R.G., A.P., U.N., N.S., M.A.M., M.B., F.S.) Heidelberg University Hospital, Heidelberg, Germany.
出版信息
AJNR Am J Neuroradiol. 2024 May 9;45(5):574-580. doi: 10.3174/ajnr.A8180.
BACKGROUND AND PURPOSE
Collaterals are important in large vessel occlusions (LVO), but the role of carotid artery disease (CAD) in this context remains unclear. This study aimed to investigate the impact of CAD on intracranial collateralization and infarct growth after thrombectomy in LVO.
MATERIALS AND METHODS
All patients who underwent thrombectomy due to M1 segment occlusion from 01/2015 to 12/2021 were retrospectively included. Internal carotid artery stenosis according to NASCET was assessed on the affected and nonaffected sides. Collaterals were assessed according to the Tan score. Infarct growth was quantified by comparing ASPECTS on follow-up imaging with baseline ASPECTS.
RESULTS
In total, 709 patients were included, 118 (16.6%) of whom presented with CAD (defined as severe stenosis ≥70% or occlusion ipsilaterally), with 42 cases (5.9%) being contralateral. Good collateralization (Tan 3) was present in 56.5% of the patients with ipsilateral CAD and 69.1% of the patients with contralateral CAD. The ipsilateral stenosis grade was an independent predictor of good collateral supply (adjusted OR: 1.01; NASCET point, 95% CI: 1.00-1.01; = .009), whereas the contralateral stenosis grade was not (= .34). Patients with ipsilateral stenosis of ≥70% showed less infarct growth (median ASPECTS decay: 1; IQR: 0-2) compared with patients with 0%-69% stenosis (median: 2; IQR: 1-3) (= .005). However, baseline ASPECTS was significantly lower in patients with stenosis of 70%-100% (< .001). The results of a multivariate analysis revealed that increasing ipsilateral stenosis grade (adjusted OR: 1.0; 95% CI: 0.99-1.00; = .004) and good collateralization (adjusted OR: 0.5; 95% CI: 0.4-0.62; < .001) were associated with less infarct growth.
CONCLUSIONS
CAD of the ipsilateral ICA is an independent predictor of good collateral supply. Patients with CAD tend to have larger baseline infarct size but less infarct growth.
背景与目的
在大血管闭塞（LVO）中，侧支循环很重要，但颈动脉疾病（CAD）在这方面的作用尚不清楚。本研究旨在探讨 CAD 对 LVO 血栓切除术后颅内侧支循环和梗死进展的影响。
材料与方法
回顾性纳入 2015 年 1 月至 2021 年 12 月因 M1 段闭塞而行血栓切除术的所有患者。根据 NASCET 评估受累侧和非受累侧颈内动脉狭窄程度。根据 Tan 评分评估侧支循环。通过比较随访影像学上的 ASPECTS 与基线 ASPECTS 来量化梗死进展。
结果
共纳入 709 例患者，其中 118 例（16.6%）存在 CAD（定义为同侧严重狭窄≥70%或闭塞），42 例（5.9%）为对侧 CAD。同侧 CAD 患者中良好侧支循环（Tan3）占 56.5%，对侧 CAD 患者中占 69.1%。同侧狭窄程度是良好侧支供应的独立预测因素（调整 OR：1.01；NASCET 点，95%CI：1.00-1.01；=0.009），而对侧狭窄程度不是（=0.34）。同侧狭窄≥70%的患者梗死进展较少（中位数 ASPECTS 衰减：1；IQR：0-2），而狭窄 0%-69%的患者（中位数：2；IQR：1-3）=0.005）。然而，狭窄 70%-100%的患者基线 ASPECTS 明显较低（<0.001）。多变量分析结果表明，同侧狭窄程度增加（调整 OR：1.0；95%CI：0.99-1.00；=0.004）和良好的侧支循环（调整 OR：0.5；95%CI：0.4-0.62；<0.001）与梗死进展减少相关。
结论
同侧颈内动脉 CAD 是良好侧支供应的独立预测因素。CAD 患者的基线梗死灶较大，但梗死进展较小。
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